The prognostic value of the WIFI classification system (wound, ischemia, and foot infection) to predict limb salvage in patients with chronic limb-threatening ischemia

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Abstract

Background
Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral arterial disease and is strongly associated with reduced survival and limb salvage rates. Classification systems are essential for clinical decision making as well as setting meaningful goals and expectations for patients and their families. The Society for Vascular Surgery has proposed the wound, ischemia, and foot infection (WIFI) classification system as a prognostic tool for amputation risk in patients with CLTI.
Aim
To assess the applicability of the WIFI classification in prediction of limb salvage in patients with CLTI (rest pain, ulcers, or gangrene).
Patients and methods
This is a prospective observational cohort study. A total of 40 patients who presented with critical limb ischemia between January 2020 and December 2021 to Ain Shams University hospitals were treated by infra-inguinal peripheral angioplasty. The study assessed the applicability of the WIFI classification in prediction of limb salvage.
Results
The study was done on 40 patients who had critical limb ischemia. There were nine (22.5%) females and 31 (77.5%) males. Their age ranged between 45 and 73 years, with a mean±SD age of 61.75 ± 7.32 years. A total of 11 (27.5%) patients required major amputation; 31 (72.5%) had limb salvage. Amputation rates were 0% for WIFI stage 1, 9.1% for WIFI stage 2, 9.1% for WIFI stage 3, and 81.8% for WIFI stage 4. The amputation group had a significantly higher prevalence of stage 4 patients (<0.001), whereas the limb salvage group presented predominantly as stages 1–3.
Conclusion
The WIFI classification could be useful to predict possibility of amputation in patients presented with CLTI.

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